Anesthesia, Resuscitation, and ICU: Q&A

Scott Allen10 said:Oh, man, I just realized—you’re *that* Victoria from the cardiac surgery corner who had the aortic coarctation and thoracic aneurysm surgery and a few other things if I remember correctly... In your case, honestly, don't take my description as gospel because everything is way more complicated for you... arterial cannulas for blood pressure monitoring, IV lines as infusion routes, using the axillary artery as the site for the ECG machine connection, cardiac and circulatory arrest, thrombosis development, etc.—all of this could have played a role in the ischemia (lack of blood flow) in your arm, which I can gather from your description... For instance, since you're from Cleveland based on what I gathered from that other thread, it seems like you went through something similar to what happened to Balthazar, except in his case, the leg ischemia lasted longer... Obviously, the causes in your situation are completely different in origin (I'm sure there was no staff error), but in both cases, the blood wasn't flowing (or wasn't flowing well) through the limb for a while, so even if surgery wasn't required, certain symptoms clearly remained.
I don't know how much I can actually help regarding the pain you described. Probably not with meds. Maybe, since you've already started some physical therapy stuff, try focusing on that. Massages and various types of physical therapy have... how should I put it... a suggestive-soothing-psychological effect that can do a lot of good. You might want to check out a Pain Management Clinic—they work across basically all Anesthesia departments—things like TENS, ultrasound, magnets, acupuncture... those are some methods they usually practice there that might help you. Ask around to see if hyperbaric oxygen therapy makes sense and if there are any contraindications given your complex medical history...
I haven't been much help, but anyway, good luck.

Ha, hahaha, yeah, that’s me, the "Jeremiah" one.😂😂 Thanks so much, Scott Allen10. Finally, someone actually explained my arm situation to me and took me seriously. (I know I can be a bit much, but seriously, 😁) As for the hyperbaric chamber, absolutely not—no way. I checked. There are a lot of restrictions for me (you know how it is, Doc). And exercise? Well, I'm limited there too, since I did sports for seven years and now this whole thing feels "old age" style, which totally gets on my nerves, but hey, it is what it is... I'll look into that Pain Management Clinic you mentioned. Thanks for the answers; people on this forum are really patient and kind. THANK YOU! 🙂

p.s. No magnets for me either, I've got a pacemaker. Figures. :P

So, I figured I’d finally show up on these boards and try to scrape together enough courage for what’s coming my way 🙂
Today I found out that I’m heading in for admissions tomorrow, and then it’s surgery on my L4-L5 disc this Friday. Not exactly breaking news, I guess, but they actually moved my appointment up by a few days, so now my stomach and my head feel like... a total firework display 🙂Having gone through childbirth before, I know from experience that I feel wayyy better when I mentally brace myself and actually face what's ahead. I don't really have anything profound to say here... just felt like sharing... it helps to let some of this fear out to people who get it...

Hi there.

On February 2nd, 2012, I’m scheduled for a total thyroidectomy at Mayo Clinic.

Naturally, that means I need anesthesia. The thing is, about ten years ago, I had a pretty bizarre experience when they were putting me under. It was mask anesthesia, and I stayed conscious through the whole ordeal—I actually went into arrhythmia and everything. The nurse told me that while it can happen, hospitals don't exactly broadcast those kinds of complications to patients in practice.

After that incident, I had to undergo another procedure that is normally done under short-term IV sedation, but the anesthesiologists refused to put me under entirely; I had to settle for just local anesthesia.

Not to mention the psychological toll that left on me. Honestly, I’m so traumatized by the memory that I might actually die of fear before they even get a chance to sedate me.

All jokes aside, what am I supposed to do now? Is anyone actually going to agree to anesthetize me? Does anyone here have experience dealing with Mayo Clinic?😢

About a month ago, they actually called the whole thing off because my bradycardia was hitting me hard. Since then, I've been running every single cardiac test under the sun and staying on top of my meds.
Now, here I am, getting ready to face the surgery all over again, and honestly, I’m sitting here wondering what's actually changed. It's still the same old me—I'm just on medication now, and we all know my heart isn't exactly pumping at full throttle.
If things go sideways, are they even going to be able to wake me up? And can they skip the general anesthesia altogether? My cardiologist basically told me I have the same level of risk as anyone else out there, which doesn't exactly make me feel any better.

Jessica Phillips58 said:About a month ago, they called off my surgery because my heart rate was way too slow. Since then, I’ve gone through all the cardiac testing and started on some medication.
Now I'm getting ready for the surgery again, and I can't help but wonder why it would be any different this time. It's still the same me—just taking meds now—and we already know my heart isn't exactly pumping at full throttle.
Will they be able to wake me up if something goes sideways? And is there any chance they'll skip general anesthesia? My cardiologist basically told me I have the same risks as anyone else.

The idea is that after a month of adjusting your cardiac meds—or cutting out the specific ones causing that bradycardia—your heart (which you mentioned is already a bit weak) should be in the best possible shape to handle the stress of surgery.
Basically, if someone is on meds that keep their heart rate low, they won't be able to naturally ramp up their pulse when the body needs it most to maintain blood flow. That lack of compensation leads to hemodynamic instability, which is where things can get really messy.
As for the anesthesiologist, they’re going to do everything in their power to make sure things go smoothly. Regarding the whole "waking up" thing, that actually depends on you—it's your body responding, not something the anesthesiologist controls.
The type of anesthesia used really comes down to the specific surgery, the surgeon, and the anesthesiologist's call. We've touched on that topic here on the forum before.
And regarding what the cardiologist said, 🙂?
Even Michael Jackson had cardiologists administering anesthesia, and well... we all know how that turned out. 🙂
Good luck.

Ugh, these cardiologists!🙂
I’ve only been on this medication regimen for two weeks—it couldn't go any faster (the diuretics, Cadillac, Amicor)
I mean, they’re supposed to take everything into account, right? They actually know what they’re doing, surely. I honestly can't even wrap my head around thinking about this stuff anymore; I am just completely over it.
I'm heading in there this Monday, feeling brave. If I check back in here in about ten days, then great, but if I don't... well, let's just say I've decided to take an extra long nap, brrrrrrrrr
Thanks for all the answers.

urbanscout50 said:When it comes to cardiologists, 🙂?
Even Michael Jackson had a cardiologist handing out anesthesia, and well, we all saw how that turned out for both of them 🙂
Good luck.

😂....👍

Jessica Phillips58 said:Man, those cardiologists... they really think they own the place sometimes!🙂
I've only been on this treatment for about two weeks now, and honestly, it feels like things are finally starting to move—it couldn't have happened any faster. Between the diuretics, my Cadillac, and the Amicor, I'm already feeling a difference.
I mean, they’ll definitely take everything into account; they know exactly what they're doing. Honestly, I can't even bring myself to think about it anymore—I've had just about enough.
I’m heading in this Monday to face it all head-on, so if you don't hear from me for about ten days, just assume everything went smoothly. On the other hand, if I stay silent, it probably just means I've decided to sleep through the whole thing indefinitely—brrrrr!
Thanks for all the info, everyone.

So, urbanscout50 was just pointing out that anesthesiology is actually the job of the anesthesiologists, not the cardiologists.

Everything’s gonna be just fine, don't you worry... actually, go ahead and worry a little, because that’s just being human, but hey, don't let it get too crazy.🙂Honestly, the people you choose to put in your corner? They’re going to give you absolutely everything they've got just to make sure things turn out alright for you.

Over the last five years, I’ve gone under general anesthesia three separate times, and honestly, every single experience felt different from the last.
So, here is what I wanted to ask the doctor.
Is there any chance that having this many anesthesias in such a short window could actually impact someone's cognitive abilities or intellect?

Look, I get it, I really do. But let’s be real here—I’m carrying an extra 65 pounds of pure baggage right now. Honestly, I’ll probably just end up being the one confusing and terrifying the anesthesiologist while I try to squeeze out a few words before they knock me out. If she can even find a way to talk to someone in my state, more power to her! Who knows, maybe she’ll just roll the dice 🙂 and some other unlucky soul will take my place instead
. When I actually sit back and think about it, I’m low-key dying to see how this whole chaotic mess plays out. 🙂 😉 😉

Alright, since it feels like I’m shouting into a void here lately, I figured I’d try asking one more thing...

Is an anesthesiologist actually required to document any complications or issues that arise during anesthesia somewhere?

jadelynx16 said:Alright... since it feels like everyone’s stopped listening to me anyway, let me throw one more question out there...

Is an anesthesiologist actually required to document any complications that pop up during anesthesia?

I guess there aren't any anesthesiologists hanging around here from the Rib area, huh?!

During anesthesia, they keep an anesthesia record where they jot down absolutely everything—what’s happening, what meds are being pumped in, vitals, any side effects, or weird incidents. Once you're fully awake—usually the next day once the drugs have worn off enough so you can actually think straight and remember things—the anesthesiologist who handled you (or sometimes the surgeon, though the anesthesiologist is the better bet) will talk to you about any hiccups or unexpected stuff that happened. This way, you know what to look out for and can tell your next anesthesiologist if anything comes up again. It helps both you and the doctor prepare for potential issues and ensures they can react fast if something does happen.
As for those arrhythmias? They happen pretty often! If they didn't give you a specific heads-up about them, they probably don't see them as a major red flag. Honestly, they can often just be a hemodynamic response to a certain anesthetic.
Since you're heading in for thyroid surgery, issues like that could also just be a result of the condition itself or how your thyroid reacts to the stress of surgery.
So, my best advice is to just lay all your fears out there for the anesthesiologists at the hospital. They’ll give you a full rundown, explain things clearly, and hopefully put your mind at ease. I really think you'll be in good hands, so try not to worry too much—don't go manifesting bad luck on yourself by stressing out!
Good luck.

urbanscout50 said:So, apparently there isn't an anesthesiologist at the Rib Hospital?!

During anesthesia, a chart is maintained to record everything that occurs—the specific drugs administered, vital signs, any side effects, and unexpected events. Once the anesthesia wears off, typically the next day when the patient is fully awake and no longer under the influence of medication that might cloud their judgment or memory, the anesthesiologist who handled the case (or sometimes the surgeon, though the anesthesiologist is better suited) will discuss any complications or adverse events with the patient. This ensures the patient remembers them and can inform their anesthesiologist during future procedures. It’s a way for both the patient and the doctor to prepare for potential issues and ensure they can react quickly and appropriately if anything goes sideways.
As for arrhythmias? They are actually quite common. If you weren't specifically warned about them, the medical team likely didn't consider them a major risk in your case. Very often, they are simply a hemodynamic response to a specific anesthetic agent.
Given that you are heading in for thyroid surgery, issues of that nature could also be a direct result of the underlying condition or how the thyroid responds to surgical stress.
That’s why it’s best to share all your concerns with the anesthesiologists at the hospital; they will perform a thorough assessment, explain things clearly, and hopefully put your mind at ease. I think you'll be in good hands, and there's no need to worry too much—you don't want to manifest bad luck just by dwelling on it.
Good luck.

Thanks for such a detailed breakdown, but just to clarify, I'm not going in for rib surgery—I'm headed to the oncology clinic.

I really feel like they should have mentioned something to me, because my previous experience left a pretty nasty impression.

And honestly... I am terrified of anesthesiologists. Brrr.😢😢😢

PS. And frankly, I don't care which doctor or which hospital is commenting, as long as someone does. 🙂 🙂

Hi everyone!
I’m feeling pretty desperate and am looking for any information, advice, or explanations you might have... I haven't dealt much with heart issues personally, so I'm trying to learn as much as possible online.
Basically, my husband (50 years old, smoker) started having vomiting and stomach pains on the evening of December 19th. He thought it was just something he ate and didn't want to go to the doctor—he spent the whole night like that. The next day, the vomiting subsided, but he started coughing and having trouble breathing. After another night at home with worsening breathing and a fever of 100.4, we thought it was probably just a virus. It wasn't until the next day that I finally convinced him it was serious, because his breathing was so rapid and shallow. On the 21st, we finally made it to the pulmonary ward with a referral from our family doctor. The doctor immediately put him on an IV and oxygen. They ran blood tests and performed a chest X-ray—it turns out he had severe bilateral pneumonia, very low blood oxygen levels, extremely low blood pressure, and his face was a bluish-gray color. They asked if he had any history of heart disease or chronic conditions. He’s never really seen a doctor, so I told them I honestly didn't know, other than that he hasn't had diabetes, though his blood pressure has always been high during the rare times we checked it. Otherwise, he's in great physical shape; he walks about 3.1 miles miles almost every day and has for nearly 30 years. He was admitted to the pulmonary ward and moved to the ICU that evening, where he was put on oxygen, medication to support his blood pressure, antibiotics, and corticosteroids, because the inflammation looked so sudden it resembled poisoning. The following afternoon, things took a turn for the worse, and he was transferred to the anesthesia unit at JLL, where he was placed on a ventilator and sedated. They told us if he survives the next 2–3 days, there might be hope. He's still on the same therapy; they explained they have to maintain his blood pressure to help his lungs. Over the next few days, he seemed to improve slightly, so on the 26th, they moved him to a hospital with a better cardiac department. He managed to get off the ventilator and stabilize his own blood pressure, so they didn't need to assist him anymore. Then, on the morning of the 28th, while on the ventilator, he suffered a massive myocardial infarction—it was huge and affected a large part of his heart. They resuscitated him at least four times between 8:00 and 12:00. An echocardiogram revealed that his heart already has scarring from previous infarcts, and that what happened on the 21st—when he was vomiting—was actually a heart attack occurring in a location that presented as stomach pain. He was started on cardiac medication along with everything else, but his lung condition worsened; he developed pulmonary edema. He needs stents, but his lungs just aren't improving. As of today, no one has given us an optimistic prognosis—in fact, they haven't given us any at all, though we can see some progress via the monitors. While he was initially on 100% oxygen with saturation barely reaching 82–83%, they've gradually lowered it; today he's on 60% oxygen and hitting a saturation of 96. There were also issues with urination after the last infarct, and his arms and legs were swollen, but that has subsided now, and they said his kidney function stabilized yesterday. When they reduce his sedation, he becomes very restless, which causes his vitals to drop. Two days ago, the doctor tried to have him breathe without the ventilator; he managed for about an hour, but as soon as he became more alert, he developed an arrhythmia and his saturation dropped, so they had to reconnect him. I'm wondering how long it's possible to be on a ventilator before further complications arise, whether this state could lead to brain damage, or dependency (since they say he requires high doses of sedation and is getting 40mg of morphine). Do you know of similar severe cases and what the survival chances are? Can the lungs heal given the state of his heart? The doctors say the lungs are the main issue, but fluid keeps returning to them because his heart is too weak. I'm interested in anything you can tell me.
Sorry for the long post.

So, my Neurologist told me today that his clinical picture is looking a tiny bit better—but he still can't breathe on his own without the ventilator to keep his oxygen levels up. There's this constant edema forming, which makes everything so much harder since a large part of his heart was damaged by an infarct. We’re essentially stuck in this vicious cycle between the heart and the lungs right now. They'll probably have to perform a tracheotomy tomorrow (I think I spelled that right?) because he's been intubated for quite a while already. Tomorrow, the cardiologist and the rest of the medical team are meeting to decide on the next steps. If anyone out there has any advice or knows anything about dealing with a similar situation before they ask me to sign off on the procedure, please let me know...

Honestly, you shouldn't even be losing sleep over whether they'll end up dependent on some medication or not. Everything else is way more pressing, especially since this sounds like an incredibly intense situation—and frankly, none of the guesswork we do here on the forum can ever replace the actual guidance from the doctors treating the patient.

I’m a little confused about the timeline, though. If I'm reading this right, symptoms started on December 19th—which clearly pointed to a diaphragmatic myocardial infarction—and then by December 28th, a new infarct was confirmed "with scarring from old ones." Was nobody picking up those old scars on a standard ECG during that window? I really hope it's not the case that they weren't running regular 12-lead ECGs or checking troponin levels in the lab, because those markers should have been obvious.

Also, looking at your description where the heart pump itself is clearly failing, I don't quite follow why they're telling you the lungs are the main issue. From what you've written, this looks like a textbook case of decompensated heart failure. Basically, because of the infarct, the heart can't pump enough blood, so it starts backing up—it pools in front of the right side (causing peripheral edema) and in front of the left side (leading to pulmonary edema). In these cases, the lung issues are a direct consequence of the heart's inability to function. The damaged heart just doesn't have the strength to push blood forward, so it builds up in the lungs. This causes the pulmonary capillaries to get overloaded with blood, and through certain physical processes, "water" essentially leaks out into the pulmonary alveoli. That buildup of fluid in the alveoli is what we call cardiogenic pulmonary edema. Having a lung full of water makes it nearly impossible for oxygen from inhaled air to reach the bloodstream, which explains the low oxygen saturation and all that shortness of breath. Treatment usually hits several angles at once with the goal of helping the pump work and ensuring oxygenation. They'll use heavy doses of diuretics, like Lasix, to try and force the kidneys to flush that excess fluid out of the system. If that doesn't cut it, they might move to CVVH or a similar type of artificial hemodiafiltration. To get enough oxygen to the patient, they'll use mechanical ventilation with a high oxygen concentration, but they try to be as gentle as possible with the settings to avoid "acute lung injury" (ALI)—basically preventing the ventilator itself from damaging the lung structures. Then there's supporting the heart pump and stabilizing hemodynamics. This often involves constant infusions of dopamine, norepinephrine, or dobutamine/milrinone, and sometimes even using an IABP (intra-aortic balloon pump) to help the heart maintain blood pressure and volume. This is usually accompanied by heavy sedation just to keep a restless or struggling patient calm so they aren't fighting the machine. We could go on about this forever, but it's not the point right now...

First off, you mentioned the crosses, so you must be from Miami. Since I'm a bit of a cardiac surgery nerd, I'm puzzled as to why treatment isn't happening right near the local cardiac surgery hub or the intensive care unit at Furlong. I wonder if a surgeon was consulted regarding emergency bypass surgery in this case? Forget about stents for a second; you've described a situation where the patient is basically "suffocating" due to a cardiac event. Things like IABP implantation or considering emergency surgery should definitely be on the table. It wouldn't be out of line to suggest a transfer to a major center like Mayo Clinic or Cleveland Clinic, where they specialize in working with VADs (ventricular assist devices) that can support or even replace heart function for a time, provided there's an indication for it.

But like I said at the start, nothing written on a forum carries the weight of a doctor's bedside opinion. I'm sure in your case, every single option has been weighed, and the treatment is moving along as it should. Good luck!

Kimberly Young63 said:So, my Neurologist told me today that his clinical picture is looking a tiny bit better, but he still can't breathe on his own without the ventilator to keep his oxygen levels up. There's this constant edema building up that makes everything so much harder, mostly because a huge part of his heart was damaged during the infarct, so we're stuck in this brutal loop between the heart and lungs right now. They'll probably have to do a tracheotomy tomorrow—I think that's the right term—since he's been intubated for way too long. The cardiologists and the rest of the medical team are meeting tomorrow to figure out the next steps. If anyone has any advice before they ask me to sign off on the procedure, please let me know if you've dealt with something similar...

If by "signing off on the procedure" you mean the tracheotomy... honestly, just go for it. A tracheotomy is pretty much necessary once someone's been on mechanical ventilation for about ten days without showing signs of weaning off. Plus, patients usually find it way easier to transition away from the ventilator after a tracheotomy compared to staying on the tube.

Definitely make sure to ask what the cardiac surgeon thinks about jumping straight into surgery. There isn't really a way to "stabilize" someone when they're in this kind of condition. If there's an indication for emergency surgery, the patient is flagged as critical and they move forward with the procedure. You should definitely try to hash this out with the surgeon. In my opinion, it’s not even a "vicious cycle"—the issue is the heart/pump itself, and the lung trouble is just a side effect of the pump failing.

Thanks for the reply—and yeah, you caught the timeline perfectly. It was only the 28th after that dramatic second heart attack when things really came to light. According to the Neurologist on duty that day, the first one was incredibly intense and hit a huge portion of his heart. They’ve now determined the heart disease is "long-standing," meaning there are older scars present. Up until that point, he had been treated for what they called "severe bilateral pneumonia." I know he underwent two or three bronchoscopies and two chest X-rays before then. As for other labs, he was admitted with a white blood cell count of 36; after a couple of days, it dropped to 27, and then just a day or two before the second infarct, it was down to 10. We haven't been given much detail regarding all the tests performed—all we were told once the infarct happened was that the initial issue was "atypical" and unfortunately wasn't recognized, which led to significant damage following the second attack. The transfer from Furlong was explained to me as a necessity due to overcrowding at JLL—they claimed he was stable enough to move then—but I later found out through others that he was actually moved because the cardio unit at the Cross is superior. No one even mentioned a surgeon to me, other than saying that stenting isn't an option right now due to his current condition. As the doctor mentioned today, a cardiologist should be reviewing his ultrasound and the rest of the team's findings tomorrow—basically, they need to huddle to figure out how to break this vicious cycle. I realize this is a forum, and I know I should stick strictly to what the doctors say, but I can't help constantly worrying about potential oversights or the worst-case scenario. I just want to find the best possible path forward—to at least know what questions to ask to see if certain solutions are actually viable for him. Right now, I feel lost; I don't even know what to ask for or demand. I am painfully aware that there was a massive oversight here—to put it mildly. From that very first night when he started feeling ill, my heart sank, but when the doctor tells you it's just pneumonia, you don't question it. I can't tell you how many times I've thought, "Lord, should I have just taken him to church instead?" Please forgive me—this is just a bit of anger and fear talking; normally, I'm quite composed. I'm waiting for tomorrow's meeting, but I'm terrified of it at the same time.

You really need to push for an opinion from a cardiothoracic surgeon—think someone like Dr. Bullard or Dr. Nenadic. A regular cardiologist just isn't cutting it here, because those two specialties are worlds apart! It’s also worth sitting down with the cardio-anesthesiologists, maybe Dr. Karanovic or one of his colleagues. I know it feels risky to judge based on how the patient is doing right now, but honestly, you should insist on getting a coronary angiogram done regardless of how unstable things look. It's not impossible to pull off. That’s the only way you’re going to get a crystal-clear picture of what's actually happening with the coronary arteries and the myocardium. Sorry if this is a bit rushed, I'm running a little short on time today, and obviously, I have to say it again: this is all just forum speculation and can't take the place of the actual doctors treating the patient. I'm just sharing what I would personally demand based on everything you guys have shared here. Good luck!

So, despite planning to see the cardiologist today—nothing happened. The explanation? A referral was sent over this morning, so he should be in tomorrow. This is the same specialist who handled the ultrasound after my husband's second heart attack—I think they mentioned Junio, though I'm not entirely sure if he’s strictly cardiology or cardiac surgery. Regardless, I’m going to try to track him down on his ward tomorrow once he arrives, just so I can hear his take personally (if that's even possible). They told me they won't make a call on the tracheotomy until after he weighs in—they've already written a referral for ENT (which makes me wonder, do specialists from other departments only show up when there's a specific referral?). Honestly, the updates I get every day at 1:00 PM are incredibly sparse—mostly just repetitive scripts. For instance, today, the doctor on duty—who is only the second one I've seen since my husband was admitted—basically just repeated yesterday's notes. I think I only saw Dr. Karanovic once back when my husband was at Furlong, and it seems like he might be on vacation right now. On top of all that, I still can't wrap my head around how the system works at JLL. People keep asking me which specific doctor is in charge of him, but there isn't one—it’s just whoever is on the rotation schedule. Based on what I heard today, it looks like it will just be the cardiologist giving his opinion tomorrow, rather than a full medical team as I was told yesterday.
Today he's on 50% oxygen and hitting a saturation of 97 (on SIMV). During those first few days, while he was on full ventilator support with 100% oxygen, he could barely break an 80 saturation level—so, looking at it that way, there is definitely progress, I hope...